Sunday, August 30, 2015

A Senior Clinician Tries To Use The PCEHR And Discovers What A Heap Of Crock It Is!

This appeared earlier in the week:

Ian Maddocks: Record of care

Ian Maddocks
Monday, 24 August, 2015
INTEGRATION of care is a common theme in health, with expectations that information technology will play a major part to bridge gaps in offering patients continuous, seamless care.
 In 2012, the federal government launched the e-health record system, where patients could register for a personally controlled electronic health record (PCEHR). More recently, the government has announced moves to introduce an “opt out” rather than “opt in” system and will rename the PCEHR myHealth Record.
The PCEHR aims to provide continuity of care by providing full details of the patient’s health care, medical contacts and interventions. But is that enough?
Access to my own record finds it is designed to advantage health care providers rather than those receiving care.
I enrolled for a PCEHR over 12 months ago, but attempting to access it recently I found considerable difficulty working through its security codes and passwords.
A recent change of address was a difficulty. When challenged by security to insert the name of the primary school I had attended (there were three), I failed to choose the one I had nominated a year ago, so I was a source of some suspicion to the system.
Even with assistance from a patient helpline adviser, I was unable to consistently satisfy the security bars. I am a fading octogenarian, lacking all but the simplest IT skills, but we are the major users of health care these days.
Eventually able to search my file, I could find a Medicare-based listing of some of the doctors and dates I had visited, but no diagnoses or opinions; and dates of pathology tests and x-rays, but no reports. There was also a list of drugs obtained through the Pharmaceutical Benefits Scheme.
As a child, I had access to fully integrated, whole-of-life health care, from a solo GP in a Victorian country town. I had home care for pleurisy (a mustard plaster to the chest), whooping cough and measles (boiled water only for 2 days), and an appendicectomy at the local hospital (open ether anaesthetic by the doctor from the next town).
When I worked in Uganda about 50 years ago, patients carried their health record with them — so the concept of a PCEHR is used in many places.
A mother would present her child in my clinic along with a bundle of small papers retrieved from deep in the front of her bosom. It contained all the child’s former consultation entries and I would add my own, to see the record disappear again into the depths.
I learned the value of a patient-held record that was never lost and always available.
Emeritus Professor Ian Maddocks is an eminent palliative care specialist, recognised internationally for his work in palliative care, tropical and preventive medicine. He was Senior Australian of the Year in 2013.
The full article is here:
This article says so much about the failings of the PCEHR.
It’s hard for older people to use, it’s incomplete and largely empty and it will be years, if ever, that Professor Maddocks, or anyone else, will see any value from the system.
What amazes me is why the geniuses in NEHTA and the Department of Health can’t grasp that they have a genuine lemon on their hands and cut their losses.
Does anyone recall just who determined the PCEHR was a good idea and can we ask them to explain themselves?


Bernard Robertson-Dunn said...

One of the comments says "Did I mention the PCEHR is inaccessible from overseas?"

Isn't one of the major claimed benefits the ability to access your eHealth record when you are away from your normal health care environment?

Blocking overseas access is mad. There are ways of getting round such geolocking, so it's not very effective anyway. So why do it?

Does the NT system have the same restriction?

johnd said...

The usability problem starts right from the start. If you want to access the PCEHR from the MyGov website, you need to scroll through a horizontal list that, initially, does not display the link without scrolling.
Once you get there, two-step authentication send you a code that is longer than any other I have seen, and gives you no indication that it is case-sensitive.
As a diabetic, I would expect my path and script history, at least. There is nothing. It is totally blank.
The only information in the record is entries related to PBS and Medicare benefits. Nothing clinical at all.
And I signed up in 2012.